Provider Demographics
NPI:1518373737
Name:MASSARWEH, KAMEL MUNTHER (MBBS)
Entity type:Individual
Prefix:
First Name:KAMEL
Middle Name:MUNTHER
Last Name:MASSARWEH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 LILAC LN APT 1125
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2788
Mailing Address - Country:US
Mailing Address - Phone:201-693-2338
Mailing Address - Fax:
Practice Address - Street 1:841 MAIN ST APT C
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3435
Practice Address - Country:US
Practice Address - Phone:201-693-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077948208M00000X
390200000X
IN01077948A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program